Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Rescued Both Lives.
Pregnant and experiencing intense discomfort, Stephanie Rosell arrived at the ER after her infection worsened up her legs. Without a job or home, separated from loved ones, she stayed in a makeshift shelter she had constructed in a companion's property. She was also addicted to fentanyl.
As medical staff managed her infection, she grew increasingly fearful. The onset of withdrawal began. She slumped forward and vomited.
Stephanie eventually collapsed. “I need to leave. I have to go home and get high.”
She had used fentanyl before arriving at the hospital and had only a brief window to get treated before she was compelled to leave to relapse. She thought she still had a month remaining to figure out how to get clean and give birth.
The attending nurse disagreed. She told Stephanie she was staying put.
“I am leaving,” Stephanie said.
But the doctors would not let her go: the leg infection was serious, but medical staff detected she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she left, she and her baby would face grave danger.
The nurse convinced the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be placed on methadone, a drug that alleviates cravings and is often prescribed in addiction recovery.
A short time later, on 12 November 2022, Stephanie had a daughter weighing 4lb 8oz – early, small but alive.
When the caregiver questioned if she wanted to embrace her child, Stephanie said “no.” She was detached. Her epidural had failed, her last dose of fentanyl had been administered shortly before she gave birth.
She felt sick. Not ready for motherhood. Not fit.
Stephanie had attempted sobriety repeatedly before birth, and felt awful each time she relapsed. She felt without value, berating herself for not being able to overcome the challenge. An OBGYN told her to “simply” stop using. Even her supplier refused to sell to her when she became obviously with child.
“But I couldn’t,” she said. “I required assistance.”
The widespread belief that her affection for her child would make her recover only led to increased guilt and self-abuse, a trigger for her to return to drugs. Yet she could not easily command her addiction away, any more than she could will away a chronic disease.
The baby was taken to the NICU. When Stephanie finally saw her her, she was hooked up to medical equipment, so small she thought she would hurt her. Embracing her at last, she felt empty. “I just stared at her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.
After two days she decided to name her baby the same as her nurse, after the nurse who had been so kind to her.
Medical personnel told her about a specialized facility, a new kind of care center where women and their babies are cared for jointly, not apart.
In much of the US, where a baby is identified with infant withdrawal condition frequently, infants are still rushed to special care and treated with pharmaceuticals while their mothers face parental assessments. But a limited but expanding group of centers like this facility is proving a simple point: when families are kept intact, outcomes improve, fewer children enter care and future expenses reduce.
It took Stephanie a period to find strength to call, but she eventually made the call. After confirming she would be a good fit for the program, two staff members came to pick her up.
She left the medical center still in withdrawal, scared and uncertain about what would happen next.
At Maddie’s Place, Stephanie still was concerned that child services would come remove her daughter – even though she was not sure she wanted to keep her. The fear lingered: that at any moment, someone could arrive and take her baby away.
For the beginning period, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I was suspicious at that point.”
Survival outdoors, she said, was about getting by. Addiction came first; faith came last.
Stephanie had a single companion, but even that bond was fragile. The people she loved always found ways to hurt her. She was unable to care for herself, let alone anyone else.
Daily, staff from Maddie’s Place transported her to a treatment center, administered in pill form. Slowly, she was beginning recovery.
She utilized each moment outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and obvious stomach troubles. She needed dietary support. She also had increased sensitivity and required an professional – all frequent conditions for babies exposed to substances.
Seeing that even a young person understands the need for care, then I was capable. I could parent.
One afternoon before Thanksgiving, Stephanie remained in the shared space, where those still using can come for supervised visits with their babies. Katie Bunch-Smith, a peer support specialist, stopped by with her own family in tow to drop off cookies. They all assembled beside Stephanie, who was seated on the ground holding Izzie.
The children were wide-eyed in wonder of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”
She holds a picture of the moment. She is clad in black pants and a hoodie, a beanie with a bobble on her head, seated on the ground with the entryway at her back. She is lean. Her head is tilted forward so you cannot see her face. She is lifting the baby on her leg for the other kids to see and they are gathered around, admiring and touching to the baby.
Jacob, eight, asked the moms: “Why are there no men?” The parents responded that the men were occupied, engaged elsewhere, that they would be there if they could.
“Once I become a parent,” Jacob said, “I will excel as a father. They will know they are valued.”
Stephanie and her companion looked at each other. “I broke down,” Stephanie said. “If this little kid could see that infants need affection, then I was able. I would become a mother.”
Methods to address babies with exposure have existed for decades.
The evaluation method was established in 1975|
